Trace Element Imbalances in Dialysis Patients With CKD: the Role of Hemodialysis

Trace Element Imbalances in Patients With Chronic Kidney Disease (CKD) Undergoing Dialysis: the Role of Hemodialysis Treatment as an Environmental Factor

Chronic kidney disease (CKD) is associated with alterations in the balance of trace elements and metals, which may result from reduced dietary intake, impaired renal function, dialysis-related removal, or environmental exposure. Hemodialysis may play a relevant role in both the removal and potential introduction of these elements. This pilot study aims to investigate trace element and metal imbalances in older patients with advanced CKD and to assess the influence of bicarbonate hemodialysis and dialysis-related environmental exposure on their elemental profile.

This is a prospective, observational, monocentric pilot study involving patients aged 60 years or older with advanced chronic kidney disease (CKD).

Participants will be divided into two groups: patients about to start bicarbonate hemodialysis (BIC-HD) and patients undergoing BIC-HD for at least 5 years, with at least 10 patients per group.

The study aims to assess blood levels of selected trace elements and metals, including zinc, copper, manganese, lead, aluminum, mercury, selenium, cadmium and chromium, before and after hemodialysis, and to investigate the potential influence of dialysis treatment and dialysis-related environmental exposure.

Blood and dialysate samples will be collected before and after dialysis, together with samples of the tap water used for the treatment. Samples will be analyzed using inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES).

Clinical and laboratory data will also be collected to investigate the association between elemental imbalances and selected clinical manifestations, including cardiovascular and infectious events, anemia, peripheral neuropathy, cognitive impairment and malnutrition. Cognitive function will be assessed at baseline and after 6 months using the FACT-Cog questionnaire.

Participants will be followed for 6 months. The study has an overall duration of 12 months, including enrollment, follow-up, sample analysis and statistical evaluation.

Inclusion Criteria:

• Patients aged 60 years or older;
• Patients attending the Nephrology and Dialysis Unit (SCDU) of AOU AL;
• Patients about to start hemodialysis (HD) using the bicarbonate dialysis (BIC-HD) technique (Group A patients) or patients already on dialysis for at least 5 years using the bicarbonate dialysis (BIC-HD) technique (Group B patients);
• Patients with stage V or Vd chronic kidney disease (CKD);
• Signature of informed consent.

Exclusion Criteria:

• Patients with previous kidney transplants (resumption of dialysis treatment after the transplant period).